Center for Colorectal Cancer, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Radiation Oncology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Clin Colorectal Cancer. 2019 Mar;18(1):e130-e139. doi: 10.1016/j.clcc.2018.11.003. Epub 2018 Nov 23.
BACKGROUND: In the Surveillance, Epidemiology, and End Results population-based data, the survival curves reversed between T4N0 (stages IIB or IIC) and T1-2N1 (stage IIIA) in rectal cancer. However, T4N0 had a higher stage than T1-2N1 in the current colorectal staging system. PATIENTS AND METHODS: We analyzed 1804 patients with rectal cancer who were treated with preoperative chemoradiotherapy and curative surgery. We grouped patients by pathologic stage, and recurrence-free survival (RFS) and overall survival rates were calculated and compared for each stage. We evaluated prognostic factors that influenced recurrence and survival. RESULTS: In the recurrence and survival analysis, 3-year RFS rates were 95.9% for ypStage 0, 94.0% for ypStage I, 78.9% for ypStage IIA, 55.8% for ypStage IIB/C, 80.2% for ypStage IIIA, 64.6% for ypStage IIIB, and 44.9% for ypStage IIIC. Patients with ypStage IIB/C showed significantly worse RFS (P = .004) than did those with ypStage IIIA. The ypStage IIB/C group showed significantly higher rates of both locoregional recurrence (24.3% vs. 5.5%; P = .02) and distant metastasis (31.6% vs. 17.1%; P = .048) than did the ypStage IIIA group. Compared with ypStage IIIA, ypStage IIB/C showed significantly higher pre-chemoradiotherapy carcinoembryonic antigen (P = .004), circumferential radial margin involvement (P = .001), and positive perineural invasion (P = .014). CONCLUSION: Patients with rectal cancer staged ypT4N0 were associated with higher locoregional recurrence and distant metastasis rates than those staged ypT1-2N1 in the current staging system.
背景：在监测、流行病学和最终结果的基于人群的数据中，直肠癌 T4N0（IIB 期或 IIC 期）和 T1-2N1（IIIA 期）的生存曲线发生了逆转。然而，在当前的结直肠癌分期系统中，T4N0 的分期高于 T1-2N1。
患者和方法：我们分析了 1804 例接受术前放化疗和根治性手术治疗的直肠癌患者。我们根据病理分期对患者进行分组，计算并比较了每个分期的无复发生存率（RFS）和总生存率。我们评估了影响复发和生存的预后因素。
结果：在复发和生存分析中，ypStage 0 的 3 年 RFS 率为 95.9%，ypStage I 为 94.0%，ypStage IIA 为 78.9%，ypStage IIB/C 为 55.8%，ypStage IIIA 为 80.2%，ypStage IIIB 为 64.6%，ypStage IIIC 为 44.9%。ypStage IIB/C 组的 RFS 明显差于 ypStage IIIA 组（P=0.004）。ypStage IIB/C 组局部区域复发率（24.3% vs. 5.5%；P=0.02）和远处转移率（31.6% vs. 17.1%；P=0.048）明显高于 ypStage IIIA 组。与 ypStage IIIA 相比，ypStage IIB/C 患者术前癌胚抗原（P=0.004）、环周径向切缘受累（P=0.001）和阳性神经周围侵犯（P=0.014）的比例更高。
结论：在当前的分期系统中，分期为 ypT4N0 的直肠癌患者与分期为 ypT1-2N1 的患者相比，局部区域复发和远处转移的发生率更高。
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